SIM Steering Committee

April 22, 2015

Disclaimer: I (Noah) arrived 20 minutes late and missed the update from Frank Johnson (Payment Reform) and some of the update from Lisa Tuttle (Delivery System Reform). There was no report from the Data Infrastructure group.

One lesson from Choosing Wisely initiative (supported by SIM) was that time constraints limit the use of shared decision making tools. Both Rhonda Selvin and Noah Nesin spoke about the need for intentional training and coaching of primary care teams to help them change their role as payment models transform.

Update on Leadership Development: Jim Harnar from the Hanley Center reported that they are convening a statewide stakeholders group of CEOs and CMOs to help develop the project, a Steering Committee to guide it, and resources to coach and support leadership teams in change management and resiliency. Critical first meeting on June 2 (they expect 75 to 100 healthcare leaders).

Risk #32 (budget proposals which threaten support for BH services): representatives Maine Health and CHCS had expressed serious concerns about the proposed budgeton SIM and MaineCare AC and BHH initiatives. That concern was shared by many other members of the Steering Committee. Dr. Flanigan took this concern to the SIM leadership team. Leadership team urges the Steering Committee to await the final budget before reacting or spending too much time on this, and urged us to focus on the objectives of the SIM grant. Noah Nesin expressed concern that this is not just a budget proposal but the Governor’s budget proposal, and the work product of some of those sitting on the SIM Leadership Committee. Dr. Flanigan reassured us that they heard the significance of our concerns.

Total Cost of Care (TCOC) public reporting: TCOC is currently being reported directly to practices. Reporting for ACOs is much more challenging. Data needs to reflect costs associated with locations where a population receives services. The issue is to be explicit about what is being measured and reported (patient behavior? Facility costs for services? PCP effectiveness?), and to be sure that the methodology accurately reflects that which we are intending to measure and report. The tool is intended to be used to understand what is happening with a population of patients, not what any individual provider or provider of services “costs”. The data cannot properly be interpreted for that purpose. The reporting will pair costs with quality reporting in ranking practices as “Good, Better or Best”. Practices which do not report corresponding quality measures will not be publically reported. Practices may use it to try and improve delivery models/work flow and impact trends in a positive manner. Frank Johnson reviewed the calculation that will be reflected in the public reporting. The measures in the adult population are around DM, HTN and heart disease. Attendance today was low so we deferred endorsement of the public reporting model until the May meeting.

Evaluation: Discussed metrics specific to MaineCare aimed at determining whether SIM is having an impact over time. The challenge is to account for confounding factors and impacts of efforts unrelated to SIM. Using claims data (about 2/3 of the data they’re using) as well as other metrics (BMI, BP, other clinical data) and patient survey data. The Lewyn Group reviewed their vetting processes for metrics, for determining benchmarks, and for the development of goals. We also reviewed some very preliminary sample data.

SIM Assessment: First, there is some hope that CMS may be more open to engaging Medicare in aligning with SIM efforts and payment models. Lisa Letourneau is currently attending a meeting in Baltimore where this is being discussed. Dr. Flanigan provided his overview of SIM thus far.

  • He complimented the people on the Steering and subcommittees and expressed his gratitude.
  • Maine SIM initiative is a model for stakeholder involvement and is held up as a national example by CMS.
  • Collaboration and consensus has been robust.
  • Risk identification and addressing risks has been successful.
  • There has been significant progress in the alignment of quality metrics and the work continues beyond that which has been supported by SIM.
  • We have agreed to a definition of TCOC for purposes of measurement.
  • Leadership development is underway and will be a key deliverable in grant year 2.
  • CDC is rolling out Community Healthworkers program and National DM Prevention Program.
  • Health Homes initiative is proceeding.
  • We will keep our eye on the big goals (Triple Aim).

Respectfully submitted,

Noah Nesin and Rhonda Selvin